3. CONTENTS
INTRODUCTION
LIMITATIONS OF CONVENTIONAL PERIODONTAL DIAGNOSIS
ADVANCES IN CLINICAL DIAGNOSIS
Gingival Bleeding
Gingival Temperature
Periodontal Probing
ADVANCES IN RADIOGRAPHIC ASSESSMENT
Digital Radiography
Subtraction Radiography
Computer-Assisted Densitometric Image Analysis System (CADIA)
CONCLUSION
REFERENCES
4. INTRODUCTION
Periodontal diseases are conventionally diagnosed by clinical
evaluation of the signs of inflammation in gingiva with or without
the presence of periodontal destruction.
The traditional clinical diagnosis of periodontitis is made by
measuring either clinical attachment loss or radiographic bone loss.
5. Limitations of Periodontal Diagnosis:
Cannot identify sites with on going periodontal destruction
Does not provide any information regarding the cause of the condition
Patient susceptibility to disease
Whether the disease is active or in remission state
Response to therapy either positive or negative
6. Periodontal disease process itself considered to be site specific and multifactorial origin in
which
periodontal pathogens
host response
genetic factors
systemic
behavioral factors interplay.
Consideration should be given to including microbiologic, immunologic, systemic, genetic
and behavioral factors in addition to traditional clinical and radiographical parameters
7. ADVANCED DIAGNOSTIC AIDS
Advances in Clinical diagnosis
Advances in Radiographic Assessment
Advances in Microbiologic Analysis
Advances in Characterizing the Host Response
Advances In Genetic Assessment
Advanced Diagnostic Aids In Detecting Halitosis
Advanced Diagnostic Tool To Study Occlusal Stresses
9. GINGIVAL BLEEDING
Clinical evaluation of the degree of
gingival inflammation include
Redness
Swelling
Gingival bleeding
Earliest clinical signs of gingivitis
consist of color and texture changes,
there may be underlying structural
alterations without corresponding
clinical signs
10. Gingival bleeding is a sensitive clinical
indicator of early gingival inflammation.
Gingival bleeding as an indicator of
inflammation has the clinical advantage of
being more objective, since color changes
require a subjective estimation.
It has also been shown of an inflammatory
lesion in the connective tissue at the base
of the sulcus and that the severity of
bleeding increases with an increase in size
of the inflammatory infiltrate
11. Lang et al in a retrospective study -
sites that bleed on probing at several
visits had a higher probability of losing
attachment than those that bleed at one
visit or did not bleed.
Longitudinal studies - failed to
demonstrate a significant correlation
between bleeding on probing and other
clinical signs and subsequent loss of
attachment.
12. A further limitation of use of bleeding as an inflammatory parameter is the possibility
that healthy sites may bleed on probing.
Lang et al demonstrated that any force greater than 0.25 N may evoke bleeding in
healthy sites with an intact periodontium.
Depending on the severity of inflammation, bleeding can vary from a tenuous red line
along the gingival sulcus to profuse bleeding.
If periodontal treatment is successful, bleeding on probing will cease.
13. To test for bleeding after probing, the probe is carefully introduced to the
bottom of the pocket and gently moved laterally along the pocket wall.
As a single test, bleeding on probing is not a good predictor of
progressive attachment loss; absence - excellent predictor of periodontal
stability.
When bleeding is present in multiple sites of advanced disease, bleeding
on probing is a good indicator of progressive attachment loss.
14. GINGIVAL TEMPERATURE
Thermal probes are sensitive diagnostic
devices for measuring early
inflammatory changes in gingival tissue.
(Kung et al 1990)
Commercially available system
periotemp probe
Individual temperature differences are
compared with those expected for each
tooth and higher temperature pockets
are signaled with a red emitting diode.
15. Probe has two light indicating diodes:
Red-emitting diode - which indicates
higher temperature, denoting risk is twice
as likely for future attachment loss
Green-emitting diode - which indicates a
lower temperature, indicating lower risk
Influence of pocket depth on temperature is
still not clear
Presence of surface cooling caused by breath
airflow may further complicate the
determination of even a normal temperature
distribution
16. Perio Temp® probe - detects pocket temperature differences of 0.1° C from a
referenced subgingival temperature
A naturally occurring temperature gradient exists between maxillary and
mandibular teeth and between posterior and anterior teeth
Subgingival temperature at diseased sites is increased as compared to normal
healthy sites
17. PERIODONTAL PROBING
The word probe is derived from the Latin word Probo, which means "to test."
Most widely used for clinical assessment of connective tissue destruction in periodontitis
Gold standard – recording changes in periodontal status
Probing depth is measured from the free gingival margin (FGM) to the depth of the pocket
Not the most objective measure of loss of periodontal tissues
Increased probing depth and loss of clinical attachment are pathognomonic for periodontitis
18. CAL is a more objective measure of loss of existing periodontal support.
CAL also does not give any indication of current disease activity.
When interpreting the PD and CAL measurements made with conventional periodontal
probes, it is important to consider that these values depend on the inflammatory state of
the tissues.
Force to probe pocket: 30g
Force to probe periodontal osseous defect: 50g
19. Periodontal probe presents many problems in terms of
Sensitivity
Reproducibility of the measurements.
Readings of clinical pocket depth obtained with the periodontal probe do not
normally coincide with the histologic pocket depth
(probe normally penetrates the coronal level of the junctional epithelium, and the
precise location of the probe tip depends on the degree of inflammation of the
underlying connective tissues)
20. Inflamed tissue - less resistance to
probe penetration probe tip either
coincides with or is apical to the
coronal level of connective tissue
attachment
Healed gingiva - increased resistance
to periodontal probing.
21. The disparity between measurements also
depends on the
Probing technique
Probing force
Size of the probe
Angle of insertion of the probe
Precision of the probe calibration
Large standard deviations (0.5 to 1.3
mm) in clinical probing results,
which make detection of small
changes difficult.
22. An ideal periodontal probe should possess specific characteristics:
1. It should be tissue-friendly and not traumatize periodontal tissues during probing.
2. It should be suitable as a measuring instrument.
3. It should be standardized to ensure reproducibility, particularly with respect to recommended
pressure.
4. It should be suitable both for use in the clinical setting where precise data documentation is
required on an individual patient basis, and for screening purposes, as in epidemiology.
5. It should be easy and simple to use and read.
23. Periodontal
probes are
used to
Uses
Detect and measure
periodontal pockets
Clinical attachment loss
Locate calculus
Measure gingival recession
Width of attached gingiva
Size of intraoral lesions
Identify tooth and soft-tissue anomalies
Mucogingival relationships
Bleeding tendencies
24. CLASSIFICATION OF PERIODONTAL
PROBES DEPENDING ON GENERATION
First generation probes:(conventional probes)
Conventional manual probes that do not control
probing force or pressure and that are not
suited for automatic data collection.
Williams periodontal probe
CPITN probe
UNC-15 probe
University of Michigan’O’
probe
Goldman Fox probe
Glickman probe
Merritt A and B probe
Probes
25.
26. Williams periodontal probe
Charles .H.M in 1936 introduced a graduated
periodontal probe known as Williams probe
stainless steel probe with markings
at1mm,2mm,3mm,5mm,7mmm,8mm,9mm,and 10mm
4mm and 6mm readings are missing in this probe to improve
visibility and avoid confusion in reading the markings
The angle between the handle and probe tip is 130 degree
27. CPITN probe
The CPITN is widely used for
screening and monitoring periodontal
findings in patients .
It was designed by George S Beargrie
and Jukka Ainamo in 1978.
Widely used in epidemiological studies
designed for recording the periodontal
findings ,recommended by WHO.
28. The probes have a ball tip of 0.5mm with
a black band from 3.5mm to 5.5mm as
well as black rings at 8.5mm and 11.5mm
weight of the probe is 5gms.
The CPITN probes to identify the
instruments as CPITN –E [epidemiologic
]which have 3.5mm and 5.5mm markings
CPITN-C [clinical ] which have 3.5mm
,5.5mm,8.5mm and 11.5mm markings .
29.
30.
31.
32. NABERS PROBE
Naber s probe is used to detect
and measure involvement of
furcal areas by the periodontal
disease process in multirooted
teeth.
Nabers probe also is used in the
assessment of more complex
clinical cases, including those
with a restorative treatment.
These probes can be color-coded
or without demarcation.
33. 2. Second generation probe: (Constant force probe)
Introduction of constant force or pressure sensitive probes
allowed for improved standardization of probing.
e.g.: Pressure sensitive probe
Constant pressure probe
True pressure sensitive probe
34. The True Pressure Sensitive (TPS) probe is
the prototype for second-generation probes.
Introduced by Hunter in 1994, these probes
have a disposable probing head and a
hemispheric probe tip with a diameter of
0.5 mm.
A controlled probing pressure of 20 gm is
usually applied.
These probes have a visual guide and a
sliding scale where two indicator lines meet
at a specified pressure.
35. In 1977, Armitage designed a pressure-
sensitive probe holder to standardize the
insertion pressure and determine how
accurate probing pressure of 25 pounds
affected the connective-tissue attachment.
In 1978, van der Velden devised a pressure-
sensitive probe with a cylinder and piston
connected to an air-pressure system.
Subsequently, it was modified with a
displacement transducer for electronic
pocket-depth reading.
36. The electronic pressure-sensitive probe, allowing for control
of insertion pressure, was introduced by Polson in 1980.
This probe has a handpiece and a control base that allows the
examiner to control the probing pressure.
The pressure is increased until an audio signal indicates that
the preset pressure has been reached.
Polsons original design was modified by its initial users: that
probe is known as the Yeaple probe, which is used in studies
of dentinal hypersensitivity.
37.
38. 3. Third generation probe:(Automated probes)
Computer assisted direct data capture was an important step in reducing
examiner bias and also allowed for generation probe precision.
e.g.: Toronto probe
Florida probe
Inter probe
Foster Miller probe
39. Foster-Miller probe
The Foster-Miller probe is the prototype of third-generation probes.
Jeffcoat et al in 1986
probe has controlled probing pressure and automated detection of the
cementoenamel junction (CEJ).
The components of the probe are:
pneumatic cylinder
linear variable differential transducer (LVDT),
force transducer
accelerator
probe tip
40. mechanism of action of the Foster-Miller probe is by detection of the CEJ.
The ball tip moves or glides over root surface controlled speed and preset pressure.
Abrupt changes in acceleration of probe movement (recorded on a graph) indicate when it
meets CEJ and when it is stopped at base of the pocket.
Under controlled pressure, probe tip is extended into the pocket and refracted automatically
when base of the pocket is reached.
Position and acceleration-time histories are analyzed to determine attachment level and
pocket depth.
main advantage is the automatic detection of CEJ, which is a better landmark than gingival
margin, because the position of the gingival margin may change depending on inflammation
or recession.
disadvantage is it can deem root roughness or root surface irregularities as the CEJ.
42. Florida probe
florida probe was developed following the criteria defined by the national institute of dental and
craniofacial research for overcoming limitations of periodontal probing .these criteria are
1. easy to use
2.non invasive
3.constant and standardized force
4.light weight
5.easy access to any location around all teeth
6. a guidance system to ensure proper angulation
7.complete sterilization of all portions entering mouth
8.no biohazard from material or electric shock
9. direct electronic reading and digital output
43. Florida Probe
The Florida Probe was devised by Gibbs et al in 1988 .
This probe consists of a
probe handpiece and sleeve;
a displacement transducer
a foot switch
a computer interface/personal computer.
hemispheric probe tip has a diameter of 0.45 mm, and sleeve has a diameter of 0.97 mm .
Constant probing pressure of 15 gm is provided by coil springs inside the handpiece.
edge of the sleeve is reference from which measurements are made, and probe has Williams
markings
measurement of pocket depth is made electronically and transferred automatically to the
computer when the foot switch is pressed
44. The Florida probe measuring a
pocket. When the sleeve reaches
the gingival margin the operator
uses the foot pedal which will
record the measurement.
45. These probes provide a constant probing pressure of 15 gm
They also can record missing teeth, recession, pocket depth, bleeding, suppuration, furcation
involvement, mobility, and plaque assessment.
Each measurement is recorded with potentially 0.2mm accuracy.
Also, there is a chart showing diseased sites, which can be used in patient education.
DISADVANTAGES
It include underestimating deep probing depths a lack of tactile sensitivity.
clinicians need to be trained to operate these probes.
46. Toronto Automated probe,
McCulloch and Birek in1991
It is used for occlusoincisal surface to measure relative clinical attachment levels
This probe was incorporated with a tilt sensor device in its handle which could identify
changes in the angulation of the probe .
The sulcus probing was done with a 0.5mm nickel titanium wire that is extended under air
pressure .
Disadvantage - difficult to reproduce patient head position and in 2nd and 3rd Molar area
47. Inter probe
also called perio probe
Goodson and kondon in 1988
Component - probe tip which is
attached to an optical encoder
transducer element ,a control unit
,memory cards and a foot switch
A fiber bundle transmits light to
the transducer and reflected light
to a signal processor.
48. Probing depth is computed by comparison
of the reflected light signal with the
reference obtained from the zero position
The interprobe is caliberated for a constant
0.3 N probing force and uses a 0.55mm
diameter plastic filament
A plastic filament with a rounded tip
extends from a plastic sheath and
measures pocket depths upto 10mm in
0.5mm increments
49.
50. 4. Fourth generation probes:(Three dimensional probes)
Currently under development, these are aimed at recording sequential probe
positions along a gingival sulcus.
An attempt to extend linear probing in a serial manner to take account of the
continuous and three dimensional pocket that is being examined
51. 5. Fifth generation probe:(Noninvasive Three dimensional probe)
Basically these will add an ultrasound to a fourth generation probes.
If the fourth generation can be made, it will aim in addition to identify
the attachment level without penetrating it.
e.g.: Ultra sonographic probe.
52. Ultra sonographic probe.
It is a non invasive periodontal probing technique
which measures periodontal pocket depth with
identification of junctional epithelial attachment
and cementoenamel junction
devised by Hinders et al
A very narrow beam of high frequency [10-15
MHZ]ultrasonic waves is passed into the gingival
sulcus and echoes of returning waves which are
reflected back from tissues are recorded
Software in computer make image automatically
53. Components
It include transducer which is housed
within a contra angled handpiece at the
base of hollow conical tip ,computer to
record and display the data separate
electron box for water pressure control
and a foot pedal
The hollow conical tip focuses
acoustic beam into periodontal tissue
and the transducer emits and receives
sound waves .
54. Calculus detection probes
detect subgingival calculus by
means of audio readings and
are reported to increase
chances of subgingival
calculus detection.
DetecTar probe (DENTPLY
Professional, Des Moines, IL)
- only calculus detection probe
in market
Calculus Detection
55. DIAMOND PROBE
This is a recently developed
commercially available instrument
developed by the Diamond General
Development Corporation, Ann
Arbour USA.
designed so that it combines the
features of a periodontal probe with
the detection of volatile sulphur
compounds in the periodontal
pocket.
56. Device has a lightweight, well-balanced
handpiece produces audible beep to
signify calculus detection (beep function
can be disengaged).
Probe may augment standard methods of
calculus detection ,it is expensive and the
handpiece is bulkier than a standard
periodontal probe
Potential for false positives and false
negatives; therefore, further research is
required.
Light signal upon detection by
DetecTar. Note thin sheet of calculus
beneath also detected.
57. Periotest
Definition
It is a device used for determining tooth
mobility by measuring the reaction of the
periodontium to a defined percussion force
which is applied to the tooth and delivered
by a tapping instrument
58. PERIOTEST SCALE
Scale Mobility
8 – 9 Clinically firm tooth
10-19 First distinguishable sign of movement
20 -29 Crown deviates within 1mm of its normal
position
30 –
50
Mobility is readily observed
Methodology
1. It measures the reaction of the
periodontium to a predetermined
percussive force applied to the tooth
2. measures the damping characteristic of
periodontium ,instrument is similar in
design and size to a dental hand piece .
3. metal rod is accelerated to a speed of
0.2m/s and maintained at a constant
speed. upon impact tooth is deflected
and the rod is decelerated.
4. Contact time between the taping head
and tooth varies between0.3 -0.2
milliseconds and is shorter for stable
than mobile tooth
ERRORS
Variation in duration
Point of application
Mode of application
Manner and duration
Time of forces
Instability variation
Slippage of device
60. • Dental radiography are the traditional method used to assess the
destruction of alveolar bone associated with Periodontitis.
• Variations in the projection geometry can be reduced by the use of
well standardized long cone parallel radiographic techniques.
61. CONVENTIONAL 2D IMAGING TECHNIQUES
traditional analog imaging modalities are 2d systems that
use image receptors like radiographic films or
intensifying screens. these include
periapical views
panoramic
occlusal
cephalometric radiography.
a digital 2d image is described by an image matrix that
has individual picture elements called pixels.
each pixel has discrete digital value that describes image
intensity at a particular point
62. ADVANCED 2D IMAGING TECHNIQUES
The limitations of traditional 2D imaging
techniques could be overcome with the
evolution of advanced 2D imaging techniques as
illustrated in like: Microradiography,
xeroradiography
stereoscopy
scanography
nuclear medicine.
63. Microradiography
Microradiography is primarily indicated for the quantitative assessment of structural features in mineralized tissues.
It is likely to produce a true radiographic image across the total thickness of the specimen
Two types of microradiography include: Conventional contact microradiography and parallel beam microradiography
which analyses the degree of mineralization of dental tissues like dentinal tubules.
However, their inherent limitations like long exposure time and need for high intensity X-ray sources precludes its use.
64. Xeroradiography
Xeroradiography is a promising imaging technique first introduced by Carbon in 1938.
In 1963, Stronezak first used it in dentistry.
It accomplishes the property of edge enhancement by which small structures and areas of minimal density differences are
better visualized.
excellent aid in evaluating initial osseous changes, assessment of osseous repair after periodontal therapy, and to clearly
visualize the crestal heights
65. Stereoscopy
Stereoscopy is a technique introduced by MacKenzie Davidson in 1988.
It is currently used for examining temporomandibular joint morphology,
evaluation of bony pockets, determination of root configuration needing
endodontic treatment, assessment of relationship of mandibular canals to roots of
unerupted third molars, and to determine the bone contour during dental implants
placement.
Despite its wide applications, stereoscopy is overlooked due to the need for long
exposure time.
66. scanography
Scanography (soredex scanora) is a commercially available X-ray unit capable of
performing both rotational and linear scanography.
It is capable of both posterioanterior and lateral linear scanning of the
maxillofacial complex.
The rotational scanography technique was found to be effective in the assessment
of periodontal disease and in detection of periapical lesions
67. DIGITAL RADIOGRAPHY
refers to a method of capturing radiographic image using a sensor ,breaking it
into electronic pieces and presenting and storing the image using a computer
68.
69. Advantages
1. Easy reproducibility
2. Reduced exposure to radiation
3. Elimination of chemical processing
4. Enhancement of diagnostic image
5. Increased efficiency and speed of image viewing
6. Excellent quality image without loss of quality commonly associated with conventional chemical processing
7. With the aid of the computer detection of defects and 3 dimensional visualization of dental structures based on
radiographic data is possible
70. Disadvantages
.Sensor size is thicker than intraoral films and therefore not patient complaint
.Overexposure and overloading of CCD sensors creating the phenomenon of blooming
Large pixels result in poor resolution and structures may not be represented accurately
.
Loss of image quality and resolution on hard copy print outs when using thermal ,laser or ink jet printers
71. SUBTRACTION RADIOGRAPHY
DEFINITION
Digital Subtraction Radiography (DSR) is a method that can
resolve deficiencies and increase the diagnostic accuracy
HISTORY
Subtraction methods was introduced by B.G.Zeides
Plantes in 1920s
Subtraction radiography was introduced to dentistry in
1980s
72. Subtraction image is performed to suppress background features and to reduce the
background complexity, compress the dynamic range, and amplify small differences by
superimposing the scenes obtained at different times
Subtraction radiography was used to compare standardized radiographs taken at
sequential examination visits.
All unchanged structures were subtracted and these areas were displayed in neutral
gray shade in the subtraction image; while regions that had changed, were displayed in
darker or lighter shades.
73. Changes in the density or volume of bone can be detected as
lighter areas (bone gain)
dark areas (bone loss)
74.
75. APPLICATIONS
study of periapical region
Study of superior surface of condyle
Diagnosis of subtle changes in bone eg. It can be used to assess bone levels
before and after periodontal therapy
76. Computer Assisted Densitometric Image Analysis
(CADIA)
a video camera measures light transmitted through radiograph, and
signals from camera are converted into gray-scale images.
camera is interfaced with an image processor and a computer that allow
storage and mathematical manipulation of the images
77. Offers objective method for following
Alveolar bone density changes quantitatively over time
Higher sensitivity
High degree of reproducibility
Accuracy
78. CROSS-SECTIONAL IMAGING TECHNIQUES
for obtaining cross-sectional information in all planes of interest has
focused towards novel cross-sectional imaging modalities
CT and its other variants namely
Cone beam computed tomography (CBCT)
Quantitative computed tomography (QCT)
Tuned aperture computed tomography (TACT)
Micro focus CT
80. A thin fan beam of X-Rays rotates around patient to generate in one
resolution a thin axial slice of area of interest.
Multiple overlapping axial slices are obtained by several revolution of
X-ray beam until the whole area of interest is covered.
With help of a computer and sophisticated Algorithms these slices are
used to generate a three dimensional digital map of the jaw which help
in evaluation of the implant patient.
81. Specialized software can be used to generate appropriate views that best
depict dimensions of the jaws and location of important anatomic
structures.
Dental Views Obtained From Ct Scan Include:-
1. Axial
2. Panoramic
3. Cross-sectional..
82. DISADVANTAGEs
Specialized equipment and setting.
Radiologists and technicians need to be knowledgeable
Higher radiation dose
It delivers radiation to whole arch.
Metallic restorations can cause ring artifacts that impair
the diagnostic quality of the image, it is challenging to the
patients having heavy metallic restored dentition.
Routine use of CT in dentistry is not accepted due to its
cost, excessive radiation, and general practicality
83. ADVANTAGE Uses
Excellent contrast
Wide field of view
Not operator dependent
Usually good soft tissue
discrimination
Very sensitive for soft tissue
calcification and bone
involvement
Completely eliminates the
superimposition of structure
To assess
anatomy for
peri implant
diagnosis
Ct scanning
helps to
detect space
occupying
lesions
To assess 3 dimensional
space of the maxilla or
mandible
84. CBCT
Cone-Beam Computed Tomography (CBCT) is a new
imaging modality that offers significant advantages for the
evaluation of implant patients
multi- modal image visualization enables treatment platform
that allows assessment of patient’s present condition, planning
and stimulation of treatment options, progress monitoring and
evaluation of outcomes
85. In comparison with conventional fan-beam
or spiral-scan geometries, cone-beam
geometry has higher efficiency in X-ray use,
inherent quickness in volumetric data
acquisition, and potential for reducing cost
of CT.
The cone beam technique requires only a
single scan to capture the entire object
known as field of view which refers to the
area of the anatomy that is captured with a
cone of X-rays
86. Indications of CBCT
Evaluation of the jaw bones which includes the following:
Pathology
Bony and soft tissue lesions
Periodontal assessment
Endodontic assessment
Alveolar ridge resorption
Recognition of fractures and structural maxillofacial deformities
Assessment of inferior alveolar nerve before extraction of mandibular
third molar impactions
Orthodontic evaluation—3D cephalometry
temporomandibular joint evaluation
Implant placement and evaluation
Airway assessment
for 3D reconstructions
87. Advantages of CBCT
rapid scan time as compared with panoramic radiography.
complete 3D reconstruction and display from any angle
beam collimation enables limitation of radiation to the area of interest.
Image accuracy produces images with submillimeter isotropic voxel resolution ranging from 0.4 mm to as low as 0.076 mm.
Patient radiation dose is five times lower than normal CT, as the exposure time is approximately 18 seconds, that is, one-
seventh the amount compared with the conventional medical CT.
CBCT units reconstruct the projection data to provide interrelational images in three orthogonal planes (axial, sagittal, and
coronal).
88. Multiplanar reformation is possible by sectioning volumetric datasets nonorthogonally.
Multiplanar image can be “thickened” by increasing the number of adjacent voxels included in the
display, referred to as ray sum.
3D volume rendering is possible by direct or indirect technique.
The three positioning beams make patient positioning easy. Scout images enable even more accurate
positioning.
Reduced image artifacts: CBCT projection geometry, together with fast acquisition time, results in a low
level of metal artifact in primary and secondary reconstructions.
DISADVANTAGES
The only disadvantage is its cost. But considering the enormous benefits, this cost effect can be overlooked.
89. Cone beam volumetric tomography (CBVT)
Another variant of CT is cone beam volumetric tomography (CBVT)
This obviates the necessity for surgical re-entry to assess outcome of periodontal
bone grafting.
It produces images that have high resolution and accuracy for measuring
regenerative therapy outcomes like direct bone fill and defect resolution
90. Quantitative computed tomography (QCT)
Quantitative computed tomography (QCT) bone densitometry is a clinically proven method of measuring
bone mineral density (BMD)
QCT is used primarily in the diagnosis and management of osteoporosis and other disease states that may
be characterized by abnormal BMD, as well as to monitor response to therapy for these conditions.
91. Micro focus CT
Micro focus CT is a new type of imaging, with special resolution of <10
mm to study trabecular bone structure enamel thickness, calcification of
human teeth ,dental root canal morphology.
Identification of bone resorption, bone to implant interface, and
visualization of fine trabecular pattern of newly formed bone.
92. Optical coherence tomography (OCT)
Optical coherence tomography (OCT) generates cross
sectional images of biological tissues using a near
infrared light source.
The light is able to penetrate the tissues without
biologically harmful effects.
93. Difference in the reflection of the light are
used to generate a signal that corresponds
to the morphology and composition of the
underlying tissues.
Feasibility of its clinical use was
demonstrated by capturing high resolution
images of oral structures including soft
tissues and hard tissues boundaries of the
periodontium.
94. Magnetic resonance imaging [MRI]
technique relies on the phenomenon of nuclear construct resonance
to produce a signal that can be used to construct an image
Purpose
To use a magnetic field to produce an image that is related to the
protons or water in organ. Soft tissues are more strongly imaged than
calcified tissues
95. Advantages
1. No ionizing radiation
2. No biological effects
3. Higher soft tissue contrast
4. Blood vessels clearly seen
5. High resolution images can be
constructed in all planes
6. MR image of periodontal tissues
before and after initial therapy might
be a useful tool for quantification of
periodontal inflammation
Limitations
1. Expensive procedure
2. Expensive equipment
3. Claustrophobic procedure
4. Relatively long imaging times
5. Metallic objects in the oral cavity such as
appliances ,crowns etc may cause artifacts
96. Radioisotope scanning
It is based on the principle of nuclear medicine absorption
of a material that emits radiation ,detection and display of
radiation in such a way so as to provide anatomical
,physiological or pathological information
97. Uses
1. Helps in detection of certain tumors
2. To detect the areas of altered bone
metabolism due to active bone loss
3. useful for clinical trials or bone
marrow transplantation that requires
immediate disclosure of possible
occult infections
Advantage
Pathophysiological information is good for the assessment of
metastatic spread.
Disadvantage
Poor anatomical discrimination
98. Ultrasonography
Ultrasound image relies upon the transmission of high frequency sound ,which is attenuated as it passes through
tissue at a rate dependent upon the acoustic properties of that tissue and upon frequency of the incoming
waveform.
Uses
1. It is useful in detecting space occupying lesion .
2. Presence of solid or cystic masses can be detected with ultrasound
3. Can detect masses present within the gland and outside the gland
99. Advantage
1. non ionizing radiation
2. Good soft tissue discrimination
3. Excellent sensitivity for mass lesions
4. Easy and rapid scanning of most of the plane
Disadvantage
Operator dependant
Limited bone formation
Poor visualization of deep structures
100. Conclusion
Although there are many potential markers for periodontal disease activity and
progression, still numerous features hamper the ability to use them as diagnostic tests of
proven utility.
There is still a lack of a proven gold standard of disease progression and thus the
correlation of these potential markers with proven clinical attachment loss may be a
potential confounder in any proposed test.
After all these years of intensive research we still lack a proven diagnostic test that has
demonstrated high predictive value for disease progression, has a proven impact on
disease incidence and prevalence and is simple, safe and cost effective.
101. REFERENCES
Choice of diagnostic and therapeutic imaging in periodontics and implantology Swarna
Chakrapani, K. Sirisha, Anumadi Srilalitha, and Moogala Srinivas Author
information ► Article notes ► Copyright and License information ►J Indian Soc
Periodontol. 2013 Nov-Dec; 17(6): 711–718
Periodontal Probing Systems: A Review of Available Equipment Srinivas Sulugodu
Ramachandra, MDS; Dhoom Singh Mehta, MDS; Nagarajappa Sandesh MDS; Vidya Baliga,
MDS; and Janardhan Amarnath, MDS march 2011 volume 32 issue 2
Imaging Techniques in Periodontics: A Review Article ,Journal of Bioscienc
AndTechnology
102. Advances In The Radiographic Diagnostic Techniques In Periodontics
Ashutosh Nirola 2 Shallu Joshi Bhardwaj 3 Madhu Gupta 4 Sunanda GroveIndian Journal of Dental Sciences.
September 2014 Issue:3, Vol.:6 r
.Clinical Relevance of the Advanced Microbiologic and Biochemical
Investigations in Periodontal Diagnosis: A Critical AnalysisVishakhaGrover,1
AnoopKapoor,2 RanjanMalhotra,1 andGagandeepKaur1 Journal of Oral Diseases Volume 2014, Article ID
785615, 11 pages
Digital Subtraction Radiography in Dentistry: A Literature review Dr. Shikha Nandal1 , Dr. Himanshu
Shekhawat2 , Dr. Pankaj GhalautInternational Journal of Enhanced Research in Medicines & Dental Care,
ISSN: 2349-1590 Vol. 1 Issue 4, June-2014, pp: (1-4)
Literature review Digital Subtraction Radiography in Dentistry E. Hekmatian DDS. MSc*, S. Sharif
DDS, N. Khodaian DDS
103. periodontal revisited shalu bathla
Carranza ‘s clinical periodontology 9th edition ,10th edition ,11 th edition
Color Atlas of Dental Medicine Periodontology Wolf, Herbert F.; Hassell, Thomas M.;
Rateitschak-Plüss, Edith M.; et al.: 2005
Three-dimensional imaging in periodontal diagnosis – Utilization of cone beam
computed tomographyRanjana Mohan, Archana Singh,1 and Mohan Gundappa2Author
information ► Article notes ► Copyright and License information J Indian Soc
Periodontol. 2011 Jan-Mar; 15(1): 11–17
Recent advances in imaging technologies in dentistryNaseem Shah, Nikhil Bansal,
and Ajay LoganiAuthor information ► Article notes ► Copyright and License
information ►World J Radiol. 2014 Oct 28; 6(10): 794–807.
